Researchsurvivor
Forum Junior
Topics: 3
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Askdoc, can not thank you enough - no one has ever guided me how to study for those exams. Of course I appreciate all the recommendations for review sources, which I got from members of this forum. I was wondering if one of the forum moderators can compile your advise in a file, which can be downloaded ( for future reference ).
Why do you recommend to gigiMD to review Patho, Micro and Pharm as the first three subjects - did you find those to be the most heavily tested? Or are those the ones gigiMD personally had more problems with? I know Pathology is the bread and butter of the exam, I know Pharm is very important, but I didn't think of Micro that much.
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| tolito
Forum Fanatic
Topics: 119
Posts: 2,174
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hi askdoc,
see all the comments you generated. practically everyone who is active on this forum has responded and even new philosophies are being propounded. i will be glad to get the result as you suggested and confirm. i promise not to reveal your name.
i like your style and the altruism too. whatever anyone may like to call it, it takes something out of one to sit down and compose such notes. i am happy that you posted your results cos it was encouraging to an old img like me cos i finished in the same 'realm' and 'dark' ages of medicine before P53 and genetic mapping. i was also very fascinated by p53. two reasons, he would respond promptly to your questions regarding what books to study. he responds to practically everyone. thanks p53. you are worthy of your name as the guardian of this forum. then i just knew the meaning a month ago. i vowed that i shall not miss any question on p53 in any guise it comes.
askdoc, we appreciate your posts and wish you a record score!!
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It has been a looooong hard journey but I am inches away from my destination...
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| mjl1717
Forum Hero
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Posts: 5,468
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tolito wrote:
hi askdoc,
see all the comments you generated. practically everyone who is active on this forum has responded and even new philosophies are being propounded. i will be glad to get the result as you suggested and confirm. i promise not to reveal your name.
i like your style and the altruism too. whatever anyone may like to call it, it takes something out of one to sit down and compose such notes. i am happy that you posted your results cos it was encouraging to an old img like me cos i finished in the same 'realm' and 'dark' ages of medicine before P53 and genetic mapping. i was also very fascinated by p53. two reasons, he would respond promptly to your questions regarding what books to study. he responds to practically everyone. thanks p53. you are worthy of your name as the guardian of this forum. then i just knew the meaning a month ago. i vowed that i shall not miss any question on p53 in any guise it comes.
askdoc, we appreciate your posts and wish you a record score!!
yes ill endorse tolito.
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Smell the coffee! "Is That an Osler move??"
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| ing
Forum Guru
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Posts: 435
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askdoc, thanks for giving great advices to us.
You don't have to prove anything to anybody. Some people still won't believe you if they don't want to. So what?
Appreciate your help and wish you the best.
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Never give up!!
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| spitmetal
Forum Guru
Topics: 25
Posts: 634
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askdoc where are u from? which specialty(recidency) did u study? when did u graduate from ur medical school? just courius..
im an img from mexico im finishing my third year of seven (im just finihing my basic subjects) im the second best in my genereation (just in grades because theres a lot of people that knows alot but i dont know why they dont get good grades) askdoc or anybody could give please some advise of what could be the best way to me to ace the usmle step 1 thanks
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NEVER REGRET IF U DID YOUR BEST--"THE PEOPLE WHO CAN'T DO SOMETHING WILL KEEP SAYING THAT YOU CAN'T DO IT.....BUT REMEMBER YOU CAN DO IT!!" by Dr. Luck a member of this forum
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| askdoc
Forum Senior
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Posts: 102
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We've discussed the concept of Mastery Know and Familiar in our Knowledge level and how this will impact our performance in the exam. Continuing our KA discussion, we will discuss 2 topics that is important in increasing our ability to acquire knowledge.
First we will discuss the difference between the way children and young adults learn versus the way adults (those in their late 20's and beyond) learn. Most people acquire their learning methods while in elem. and high school and continue using the same methods even when they are no longer applicable without some modification.
Second, we will discuss speed reading. Increasing reading speeds 10 to 20 times faster may take years and is impractical for our purposes. However, increasing reading speed by 25, 50 maybe even 100% is achievable within a few weeks and just may be what most of us need to be able to acquire knowledge faster and go through questions faster and fare better in this examination.
When I was in Med School we had a subject called Pedagogy or the science of teaching or learning. It was one of the little 3, Pedagogy, research methods and management which most of my classmates look with disdain and did not take seriously because it is not "Medicine". You see our school wanted us not just to be doctors but also educators, researchers and administrators. In my case, I was fascinated enough with the topics to go beyond what was taught and do my own research, even after graduation. I came upon a discipline called Andragogy, which is a subdiscipline under pedagogy. Pedagogy, root word "Pedia" concerns itself more with how children and younger people learn, while Andragogy root word "Andro" (for Androgens) meaning Man or Adult, concerns itself with how older people acquire knowledge.
To understand why children and adults learn differently, we have to go back to basic developmental neurophysiology. I have not found any book which effectively discusses this topic, however, what I know of it, I've gathered by reading various Journals mostly in Science and Scientific American. Some concepts may even be found in Guyton. I'll present this in shortened form as a whole treatise may be a book by itself.
How do we learn and how does it get stored in our brains? One theory is that when we learn something new, a neural connection is formed between an axon and dendrite which represents that information. When the learning is repeated, the connection is strengthened and we tend to remember that information longer. Therefore, repeated reinforcement will lead to more permanent learning and that explains why we were taught our ABC's by repeated reading. However, some believed that continued repetition increases the number of neural connection we create and that is the basis for stronger retention of the information. My own thinking is that it is a little bit of both.
From birth to about 10 years of age, our nervous system is an empty page with tremendous potential for learning. There is very little neural connections between axons and dendrites. AS the child grows, neural connections are formed and with repetitive learning, neural connections are strengthened and duplicated. However, after the age of 10 or thereabouts, the neural growth pattern changes. Strong neural connections are strengthened further while weak connections are eliminated ruthlessly. This explains why children have the infinite capacity to learn but lacks mastery and tends to be clumsier, while adults lost this capacity to learn, but what they know, they can master to the fullest. This applies to all types of learning including mental, physical etc.
By the time we hit our 20's the process of specialization is almost over. Most of us can still learn by just mere repetition, but usually slower and with more effort than those who are younger. This also explains the rather curious finding that Japanese children who never learned to speak another language until after 10 always have extreme difficulty with their l pronouncing them as r. This is because there is no l in Japanese.
Most people still try to learn new things by repetition, but keeps on wondering why they keep on having problems retaining them. This is because adults have lost the capacity to learn by pure repetition. What they already know they can strengthen their retention by repetition. What they do not know, they will have a hard time retaining by pure repetition. This becomes more so as they grow older.
So how do adults learn? By Association. Since Adults cannot form new neural connection, They have to utilize a previous neural connection to build a new one. This is helped a lot by the development of abstract reasoning ability in adults. This abiltiy helps to learn by association. After that, mastering is by just pure repetition
Children can learn unrelated information by pure repetition. When they learn a new information that links 2 previously unrelated information, they can just correlate and continue. This is akin to cementing a driveway. You can cement different parts of a driveway and connect them later.
Adults cannot learn unrelated information. They need to relate that information to something they already know before they can learn it. It is akin to constructing a building. If you have built the first floor, you cannot build the fifth floor until you have built the second, third and fourth floor first.
To Illustrate:
The biochemistry and genetics section in Kaplan Notes is great. Except that when I first read it, it looks greek to me (If you're greek, it probably looks chinese to you!) Anyway, so I decided to use Lippincott instead. After finishing Lippincott, reading Kaplan was a revelation. There were many concepts you could not master with Lippincott alone, but without Lippincott, I could never learn the concepts in Kaplan Notes let alone master them.
I have a 1996 edition of NMS Genetics, which I read. About 90% didn't show up in the exam and I knew this. However, I needed about 50% of the material in the book to understand the 10% that is tested in the boards. It also helped me understand the genetics section of Kaplan Notes better.
So what implication does it have on our learning process?
1. IF you find yourself having a hard time retaining some information, it maybe because you are trying to memorize information unrelated to what you already know. The solution may be to consult a more basic text so the information could be more readily retained. After that mastery is by simple repetition.
2. At times, you might have to learn board-irrelevant information to understand concepts tested by the board. Do not hesitate to do so if you think that this is the case.
3. When like me, you are faced with a lot of new concepts that you do not know, do not start your study by trying to master or memorize anything. Start reading first to understand the concepts. If you hit the fifth floor in your reading, continue and by the time you finish, you've already found your second, third and fourth floor that the fifth floor becomes extremely understandable and masterable already.
4. This is also the reason why it is harder to increase mastery of a concept by doing q's alone especially if the problem is KA. The information is isolated and may be unrelated to what you already know and therefore retention is harder without associating it with a whole concept.
5. It is easier to learn different interrelated concepts as a group rather than learning this individually. Although sometimes this is not the way it should be recalled. For example, it is easier learning drugs in groups and as I said previously by 'mastering the prototype, knowing impt. derivatives and being familiar with the more obscure derivatives" But recalling them, esp. in relation to the exam requires you more often to do it on a per drug basis rather than by class, therefore a good recall tool is flashcards. The same can be said of Microbiology. Learn it using books, practice recall using flashcards.
If you discover or know some things based on this learning concept, feel free to give examples and share your experience to help others.
Now we go to speed reading.
The main reason that we read so slowly is the way reading was taught to us when we were younger. The two main reasons is:
1. We tend to read word for word.
2. we tend to subvocalize when we read.
Why we read word for word has to do with how we were first taught to read. We first learned our ABC's. Then we learn to put together letters to form words. We know group of words form phrases, group of phrases, sentences and group of sentences, paragraphs. Most relatively good readers tend to read in phrases than words, however, skilled speed readers can read in sentences, in paragraphs or even in pages. I know one guy who can read at the speed of 1 page per second. At my fastest I can read 3 lines in one glance depending on the difficulty level of reading.
Generally, there is no reason why we should be reading word for word. When our minds processes images in our visual cortex, we can recall random object scattered in our field of vision because that is how we have trained our brain to process that information. We can also train our brain to process the written word that way.
By just expanding our reading from reading words to phrases or phrases to sentences, we can practically increase reading speeds up to 100% faster. There are exercises to accomplish this and I will tackle this later.
We also tend to subvocalize what we read because our teachers taught us to read aloud since this is the only way they can judge whether we have learned to read or not. This has become a habit for so many people that is hard to correct.
Subvocalization means reading like you were talking to yourself. Studies have shown that people actually use their vocal cords when they subvocalize even if no sounds are produced. Others even form the words with their mouth as they read.
Subvocalization slows down our reading so much simply because it involves so much of our brain. If we trace the neural pathways, we start with the eye going to the visual center in the occipital area through the visual association areas that govern reading, then to Wernicke's area which mediates symbolic language. Then this travels to Broca's area via the arcuate fasciculus, to the motor area, then to the vocal cords and facial muscles, then back to the somatosensensory areas, then the somatosensory association areas then going back to Wernicke's area, before it is sent to the hippocampal area for storage. By not subvocalizing we could start reading at the speed of thought. Now wouldn't that be great.
For those who find themselves reading word for word, the best way to improve reading speed is to start reading by phrases. This will also reduce subvocalization.
For those already reading in phrases, expanding to read in sentences is a bit harder. A system taught in speed reading class is to use your index finger to lead your eye across the words. Move your finger at a speed faster than you are comfortable with, after reading a section or a group of paragraph try to write down what you recall of that paragraph and reread the same page at a slower pace to compare how much you've recalled. Initially your comprehension rate will be low as your brain is not used to processing information that way, but as time progresses it will become easier and your comprehension and retention will increase but at 2 to 3 times the speed.
One major limitation of speed reading is the requirement that you be able to think in the language you are speed-reading in, in our case English. The reason is if you have to translate English to your native language everytime you read, this will slow you down considerably. You can be translating this in your head and this limits the speed you can actually achieve.
Improving reading speed helps both in the KA phase and TP phase. By reading faster, we can increase the amount of material we can cover in the same amount of time. Of course in the TP phase, faster reading must be coupled with faster recall and I've discuss a way of doing that previously.
To end this discussion, I would like to quote my English Professor, Professor Concepcion Dadufalza, " If there is only one thing you take with you when you leave this University, that is, Learn How to Learn, I will consider it our biggest success in educating you."
Our next topic for discussion will involve, the use of books in reviewing. I will introduce a way of classifying books and how to use them. Of course, I will confine myself to books I have used, or those which I have bought but have decided not to use. That will be the last topic in KA, then we will proceed to KR. To Arrhythmia, the next post will answer your question and more.
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Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| askdoc
Forum Senior
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Posts: 102
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To ResearchSurvivor: The 3 most tested subjects is Patho/Pathophysio, then Pharma and Micro-Immuno about equal. Behavioral Science Next. This is followed by Biochem/Genetics, Physiology and Anatomy. Most of Physiology is Pathophysiology, pure Physiology is relatively less, about equal to Biochem/Genetics and Anatomy or even slightly less. had only about 12 Q's in Mol. Biology. To be clear, there is less Micro then Pharma, less Immuno than Pharma, but Micro-Immuno combined about equal to or slightly more than Pharma.
To spitmetal: Sorry about not answering you. But just posting my score is enough to stir controversy. Posting the other information may create even more problem. I'd rather my post be judged for it's content so that it can help anyone who needs it, rather than be judged by who I am. I've made mistakes of posting information about myself unrelated to the main posts and I fear that that may jeopardize others perception of my post.
My desire is to post a road map or guide which people can follow as they go through their preparation process. Where they can identify where they are in the process and proceed from there. It was never intended to tell people to follow it hook, line and sinker or to insist that this way is the only way. I've always kept this proverb posted on top of my study desk back when I was still in school. "There is no one road to success, there are as many as there are men willing to build them." This is my way, and people should feel free to follow them if they want to. There are other ways and people have the freedom to build their own and hopefully share them with others, so that others may benefit from them.
till next post!!
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Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| p53
Forum Guru
Topics: 51
Posts: 804
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very interesting, askdoc, especially about reading speed - though you haven't yet explained to us HOW exactly we can switch from reading words to reading phrases and so on - I'm still reading words when I'm reading; yes, you said 'There are exercises to accomplish this and I will tackle this later' - so, I'm looking forward for your next post.
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| ninety_nine
Forum Newbie
Topics: 6
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To Askdoc : I have trouble focusing for 8 hours . After 4 hours i really get bored (on exam) and i dont care any more .M sure this happens to many of us (or mayb not) , so how do i train myself to increase my endurance, what is ur suggestion? Thanx.
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| Researchsurvivor
Forum Junior
Topics: 3
Posts: 39
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p53 wrote:
very interesting, askdoc, especially about reading speed - though you haven't yet explained to us HOW exactly we can switch from reading words to reading phrases and so on - I'm still reading words when I'm reading;
I also read slow - subvocalizing words in my mind. SO I bought a book through Amazon.com on Speed reading ( the forum says no advetisements). Anyway - you can check the titles yourself. The exercise which I use is to first say "one" and move your index finger from left to right on the page in one second. Say "one" like this following each line and try to move your eyes along the line. Do this for the whole page - you wouldn't be able to read anything at first. Than move your finger at approximately the same speed along the line w/out saying "one", but trying to read the line. You'll see that you'll be able to read few words. Keep trying this and always use your index finger as a "motivator" to move faster along the line. Eventually this teaches you to read faster. In the book on Speed reading there are many more examples of exercises, but that's the main one.
Honestly - I have hard time studying and speed reading. But I definetely managed to read few science fiction books and novels since last fall - something I usually never had time for since High School. Read "the DaVinci code" in couple of days for example. I do think this also increased my reading speed in general, though I have hard time studying Pharmacology for example and speed reading - doesn't work for me.
As far as I remember from that book, Winston Churchill used to be able to read a book during breakfast time. I think was Churchill! Or was it GWB 
Edited by Researchsurvivor on 05/29/06 - 08:52 PM
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| askdoc
Forum Senior
Topics: 5
Posts: 102
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For people who are content with their reading speed or in any way does not think much of speed reading, feel free to skip this part as this is going to be a long post.
I had hoped that by just listing some benefits of speed reading, a short albeit incomplete discussion of speed reading and how to drill for it, that people will at least try the method. But I guess, the much derided finger reading method strikes again. Discussing speed reading in detail entails a whole book, I'll try to accomplish that at considerably less length.
Over 40 people attended the introductory speed reading seminar given while I was still in High School. Everyone was impressed with the "Reading in Phrases" part and even "reducing subvocalization" and "subvocalizing only in your head." But the lecturer probably lost half the audience when he brought up the finger reading method for speed practice. Only 7 of us signed up for the 14 day program and only 3 of us finished it. I have never regretted it and it has had a profound influence in my life.
Since then, I've often been approached by friends and acquaintances (incl. classmates) who asks me how I read so fast. Most would listen attentively until I mention finger reading practice and their eyes would glaze over and that was the end of it. Only in very few instances, were people willing to try it out and were able to achieve some improvement in their reading speed. One friend even blurted out "You mean, I just wag my fingers and poof, I start speed reading", completely forgetting that I was living proof that it works and that he was the one who had approached me to find out how I can read so fast.
There are a lot of fallacies surrounding speed reading, and I would like to tackle this before our main discusssion. Speed reading is a tool and like any tool, there are situations where it is useful and there are situations where it is not. Subsequent discussions will explain why this is so.
Situations where it is not useful is as follows:
1. When trying to memorize tables or bulleted list of items.
2. When trying to read and appreciate poetry.
3. When reading fiction that you really like and want to savor every word and every turn of the phrase, or even the lingering scenery and emotional situations that you want to experience while absorbed in the wonderful prose.
4. When you are proofreading something word for word.
Situations where you can use speed reading but at a much slower speed (Take note that non-speed readers will probably be tackling this at an even slower speed than you are)
1. Reading that requires analysis not just pure retention. Your analytical speed (w/c is a function of IQ) may not be faster than non-speed readers and therefore your average speed will go down.
2. Reading materials where information is more tightly packed than normal writing, like summaries or abstracts, etc.
3. Reading materials that were poorly written, or written in a convoluted manner.
4. when you are trying to learn new materials unfamiliar to you.
Situations where speed reading is ideal
1. When you only need to know the gist of the material you are reading and some additional details. This is extremely useful for example when you have to churn out college book reports and have limited time to do so. The amount of detail you retain in speed reading is affected by your reading speed. Slowing down almost always increase comprehension and retention up to a certain point. If a speed reader whose base reading speed in 500 wpm slows down his reading speed by half to say 250 wpm, his comprehension will go up in the same manner a non-speed reader whose base reading speed is 250 who has halved his reading speed to 125 wpm. In either case, the speed reader will always be able to read and understand more faster.
2. When plowing through large textbooks, such as Harrison's, Robbin's etc. These texts are so conducive to speed reading that I can't emphasize it enough. Although I do use smaller texts like Cecil's Essential for example since this is easier to carry in the wards, I find no problem going back to Harrison's if needed for better understanding of the topic.
3. When revising material you already know for mastery. When you are trying to learn something new or need to analyze what you are reading, you cannot go very fast. But once you know it already, you can revise it at speed reading level going through the material 3 to 4 times in the same amount of time non-speed readers would take to go through the same material once. I can't emphasize enough what this can do for your revision for USMLE or any other exam.
Speed Reading is also useful in Step 2, especially when dealing with those kilometric stem questions. However, this is limited by the fact that, based on what I can discern from posts and the few questions on Step 2 I have seen, step 2 tests your decision making ability more than the amount of information in your head which in contrast is all important in Step 1. (This is also probably the reason why Qbanks are more helpful in raising scores then FA in Step 2 and why FA is more useful in Step 1 than Step 2, You learn to make better decisions with questions and you don't get the same benefit when you just read and memorize.) However, between 2 people with the same decision making ability, the one with the more facts in his/her head will be able to make better decisions. (Caution: this is just my preliminary analysis of Step 2, I reserve the right to revise my opinion when I have more experience with it.)
The above list is not complete, and there are a lot of other situations where you can or cannot use speed reading.
Let's discuss how speed reading works:
Let's look at a basic sentence, for example:
The man went to the park to eat.
A person who reads word for word will subvocalize and "read" all eight words.
A person who is reading in phrases will tend to read it this way without loss of comprehension.
the MAN - WENT - to the PARK - to EAT
He/she still "reads" all 8 words but subvocalizes only 4 (those in full caps). The other words will seem to be a blur but if the reader will try to recall it, he/she can remember that it's there. As you can see, this can easily double your reading speed. A lot of people seem to be able to naturally get the hang of this and develops the ability on their own. Some develops this ability once it is pointed out and with some practice. A few are completely unable to develop this ability without the much derided finger method.
Most people need to subvocalize to retain something. However, you can speed up your reading even more if you just 'subvocalize' in your head and not with your vocal cords, tongue or mouth. The only way to do this is to go through the words so fast that it is impossible for you to use your vocal cords, tongue or mouth because they are not fast enough. This will increase your reading speed even if you are still subvocalizing every word.
The maximum speed you can achieve when subvocalizing every word is roughly 4 wps or 240 wpm. Hence, you need to read in phrases to go beyond that speed. It also goes without saying that if you are using your vocal cords, etc. when you are subvocalizing, you are going slower than that.
You can also develop the ability to read in phrases by deliberately increasing the speed your eyes plow through the words line by line such that you are unable to subvocalize every word. Initially it would be hard and your comprehension will drop a bit, but eventually the key words will pop out in your field of vision and you will subvocalize only them.
Understand that even if the words are a blur as you are looking at them, your eyes are registering them and sending the image to your visual center, except that higher centers discard them because you've trained them to take note only of words you have stared at and subvocalized. In time, your brain will be aware that it must take note of everything your eyes have read, analyze it and pop out only those words that are important for you to subvocalize. It is "reading" every word not just the ones that seem to pop out.
This is akin to the way you recognize any object in your field of vision. Your eyes sees the object only from one perspective and yet it is able to integrate it probably with other views of the object in your memory and you recognize the object without seeing the whole of it. This is the basis for most illusions. In advanced speed reading, your brain may even drop whole sentences from your attention especially on familiar topics, since it has read it (although you may not be conscious of it) and it can recreate it from memory for you, even if not always perfectly, if you need it. But first of course you have to train it. (This is the reason you cannot proofread word for word, your brain will put in the correct word when you recall it so you will not 'notice' the error. Just as it can be fooled by illusions, because it did not 'notice' some details.)
However, for most people, it is impossible for them to increase their speed to reading in sentences and beyond or even stop subvocalizing with their vocal cords, etc. completely without the use of the finger reading method.
So what is this finger reading method.
As posted by researchsurvivor, the finger reading method is when you use your index finger to underline the text you are reading. Your eyes try to follow your finger as it slides across the text. The reason why you use your finger is so that you can force your eye to go faster across the text then you are comfortable with. I'll describe my own feelings as I went through the excercises when I first tried it since this will probably be akin to your own.
At first as my eyes followed my finger, the words behind it was a blur, but I did manage to snatch a word or two, and after finishing the paragraph, I wrote down the word or two I got. Then I read the paragraph again, slowly this time and the initial result looked pathetic. However, the more I practiced the more it becomes easier and the more I retain. Now whenever, I speed read anything, important words just naturally pop out in my field of vision, other words are just a blur and yet the result of my reading has not in any way lowered my comprehension. I don't even use my finger anymore, since using the finger can limit your speeds to below 700 wpm.
Even when the words seem a blur, my eyes were registering the words and sending it to my visual center, but somewhere in my brain, it is not registering it to higher centers since I have taught my brain to only retain information that I have looked at specifically for a certain amount of time and read (ie. subvocalize). Which is why doing the recall immediately after reading it, then reading it again, this time in the slow way trains your brain to start registering anything you have read, even if you have not subvocalize it. Eventually, your brain will automatically analyze anything it has read and only pop out to your conscious mind what it has decided to be important words for you to subvocalize and retain. But it has "read" every word, not just the ones popping out for you to subvocalize.
Someone might say, it's just like scanning and in a way it is, but not really. I have thought so at first, but without the training, scanning does not really retain anything. Your eyes may be moving through the text at the same speed as an ordinary reader is scanning through it say 900 wpm, but you are comprehending it and retaining information at the same level as an ordinary reader is 'reading' it at say 200 wpm.
I would like to emphasize certain facts about speed reading to ensure that the concepts are clear. Speed reading is most useful when reading topics you are already familiar with. When reading unfamiliar or unknown topics, or materials that require a lot of analysis, you will slow down your reading speed since either your analytical ability is not faster than anyone else(w/c is a function of IQ) or you just have too many facts to pay attention to that it slows you down. But remember, you are still reading it at a faster speed than non-speed readers.
When I was still in Med School, a group of us would study together and start reading the material before discussing them. I would stand up after some time to get something to eat. My friends were expecting me to come back and start reading again and were surprised that I have finished and was actually waiting for them. Most of them were just halfway through. And we're talking about Harrison's here. I was probably reading at just over 150 wpm at that time, but everyone else slowed down even more.
The reason that people who read in phrases do not have to subvocalize the word "THE" is because your brain already knows that the word "MAN" is almost always preceded by either "THE" or "A" and it can recreate that memory for you if needed. It just presents the word "MAN" for your attention. The same can be said of "TO", "FOR", etc.
Now advanced speed readers can extrapolate that same principle to sentences, paragraphs or even whole concepts. A lot of times, in very familiar materials (especially when I am revising a previously learned material) whole sentences may not even come to my attention while I speed read and yet it can still be recalled later when tested in an exam.
Of course achieving this level of skill may not be possible in a couple of weeks. But learning to read in phrases, eliminating subvocalization using your vocal cords, etc. and occasionally being able to drop a couple of phrases from your attention while speed reading very familiar materials can increase your reading speed tremendously.
If you succesfully get a residency and complete it , you still face a series of specialty examination and getting this skill now will give you a leg up by the time you have to face these examinations in the future.
Two other causes of slow reading can be "cured" by using the finger reading method.
1. Reading Regression.
Regressions slow your reading rate rate considerably. As stated previously the maximum speed you can achieve when reading every word is around 240 wpm. and if you regress a lot, your speed is much much lower than that.
There are 2 kinds of regression, conscious and unconscious. You may sometimes feel that you did not understand something well enough that you decided to go back and reread. This is conscious regression and nothing is wrong with it. It is not the best way to increase comprehension but it is a way.
Unconscious regressions are the result of bad habits you learned while reading and can be cured by the finger reading method.
2. Mind wandering.
As everybody is well aware, people have a limited attention span. After sometime, the mind begins to wander. This forces you to regress a lot, since your mind tends to wander a lot. The finger method forces you to pay attention to what you are reading longer. And more importantly, since attention span is a function of time, the faster reading speed allows you to absorb more material before your mind starts to wander.
Like any skill, the only way to gain this skill is by practice. If anybody remembers the first time they learned to swim or to drive, you know you have to practice to gain this skill. No matter how well they taught you to drive in the classroom, the first time you actually tried to drive was probably embarassing. The car would start, then lurch, then die, until you get the hang of it.
So how long do you have to train for this. Well the original course I took was 2 hours a day for 14 days. By the end of the program my reading speed had doubled to around close to 400 wpm. Maybe because I was young then, around 16. Some of the people I've taught and have at least doubled their speed were over 30. (Although it did take a little longer for them to get the hang of it). Remember you can train yourself once you know the basic principle. You don't have to apply to a course or buy a book.
Although my top speed now is just over 1000 wpm for light material, I don't read fiction I like at that speed. I usually like to savor the words, the turn of the phrase, etc. and reading it slowly is the only way to do that. Speed reading is a skill and like any skill you don't have to use it all the time. But it does come in handy when you need it. (like in the USMLE).
Writing this topic in detail has pushed back my next topic on books, but I'll try to get that in by Thursday.
___________________
Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| askdoc
Forum Senior
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To all readers of this posts.
Would like to thank you all for taking the time to read my posts, however, I would like to ask for your indulgence. I would like to finish all my posts by at most next Wednesday, as I have to begin my preparation for step 2. Writing this posts do take an extraordinary amount of time and I've found it hard to start preparation for step 2.
I will temporarily stop responding to questions until such time as I've finished my posts. In fact, I may even temporarily stop reading the questions until I finished the post. I'll start reading and answering them after my last post which hopefully is Wednesday.
Some people are already impatient and asking questions that rightfully belong to the KR or TP phase, so I believe I should speed up. Not reading and trying to answer questions should help.
I'd also like to state that the biggest mistake I made in preparation for Step 1 is in the TP phase. I over-estimated my ability to handle an 8 hour exam. I'll explain this in detail when I discuss TP including what I had done and what I think I should've done if I had enough time. That's one of the reason why I wanted to postpone my exam. But as KREJ pointed out, with a 740 NBME and 84% Kaplan QBank, was a two week extension worth it and how much additional points will I make?
The coming days will show whether I made the right decision or not. The discrepancy between my predicted score and my actual score will decide it. Even though NBME score correlations had taken into consideration the difference in testing condition between the NBME ( 4 blocks, 4 hours at a sedate and comfortable environment) vs. USMLE (7 blocks, 8 hours under tense situation) different people react differently to stress and the level of performance deterioration is unpredictable.
After that, the next time you'll hear from me is probably after I've finished Step 2. Whatever, the outcome of my preparation for that, I will endeavor to write my analysis and experience on that too.
___________________
Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| askdoc
Forum Senior
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Posts: 102
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When I first started preparing for step 1, I was faced with the enormous task of deciding what books to buy and use. The first thing I did was do what almost everyone recommended that everybody should do, buy FA. However, after reading its book list and various posts in the various forums, I decided to junk their recommendations, although I did use the booklists to know what books are available out there. It was counter-intuitive that they are placing a premium on books that discuss as little as possible about topics tested in an exam that tries to find out how much you know about these same topics. Suffice to say I eventually created a system to decide how many and which books I needed. Which is the reason why I ended up not using some books I have bought and buying additional books I don't have.
So I classified books I needed into the following category. (Sometimes one book can fulfill 1, 2 or 3 categories and so I do not necessarily have 1 book for each category under each subject.)
1. Guidebooks
As we said before, the board expects you to master certain concepts in the examination. Guidebooks are books that contain the concepts you need to master. On most occasions this is what is rated highly in FA. However, the problem is most guidebooks or high-yield books also contain too little details for you to be able to master the topics presented. On the other hand, guidebooks are also good books to use for practicing recall.
2. Main Text.
This is the main book you are reading to gain mastery, know and be familiar with the topics that the board requires of you. It should contain enough details that you could master important topics with it. And the bulk of your KA period should be spent on this book.
3. Supplement
These are books you use if the discussion on your main text is insufficient for you to master high yield concepts. You should only be using this occasionally. If you find that you are using this too often, you have to re-evaluate the quality of your main text.
4. Introductory
These are books you use because your current knowledge is insufficient for you to understand your main text or supplement. Most people do not really need this but some do, especially older graduates. This will usually covers Biochemistry, genetics and molecular biology. Sometimes Immunology and Pharmacology and rarely physiology.
5 Clinical Supplement.
Due to the increasing clinical slant of step 1, there is a need to study how diseases present clinically. This is esp. impt for 2nd year med students, old graduates who were out of medical practice for some time, specialists, whose practice was focused on community outpatient care (like me) or specialists who although hospital based was concentrated on cases not usually presented or covered much in Step 1 (ie. Anesthesia, Surgery, Radio, etc.)
6. KR books
Some people may ask if they need this when there are good online qbanks out there. Actually I willl tackle this in more detail when we reach KR. Suffice it to say that it is faster and more efficient to master information in a KA/KR cycle like I outlined previously, even more so if the KA/ KR is done topic by topic. QBook is good, but it is done by subject and not by topic. Online QBanks are most expensive and are better used for increasing your random KR ability and test preparedness. Also as noted above, you can use guidebooks for KR.
Comprehensive step 1 books
Actually I used two books for this part.
1. First Aid
Aside from using the book list in this book, I used this book primarily for KR. I used it 3 days before the exam to double-check how well I can recall all the topics in it. ( I used 2004 ed)
Some people will use this as their guidebook for all subjects and I see nothing wrong with it so long as their KA is OK with only some gaps.
The problem with FA is that although it probably is the most comprehensive guidebook or high yield book around, it does not cover the material in great enough detail for you to know it well, let alone master it. Most materials are covered in enough detail for you to be familiar with it. If your KA is already very good (since you are a fresh graduate with high grades, or you have completed your KA before and are now doing a final review or KR.) feel free to use it. Read through it and when you come across any concept you feel you have not mastered, be ready to consult your main texts.
2. Step Up for USMLE Step 1
This book is system based review book in the mold of First Aid although not as comprehensive. To understand how I use this book, you must understand my circumstances and how I approached the problem. If your situation is like mine, this may be of use, but if not feel free to discard.
Being an extremely Old IMG, I was in a position of knowing too little on far too many things. Plus I feel it will be easier for me to learn concepts if I try to integrate them from the very start. I've divided my preparation into the learning integrative phase and mastery phase.
I used this book as my guidebook in the learning integration phase. I integrated anatomy, physiology and pathology and the clinical books, namely Blueprints Medicine, Pedia and OB-Gyn. I will cover each organ system by first reading this guidebook, to anat and physio, to relevant chapters in Blueprints, then to Patho (BRS and big Robbins). There was no attempt at mastering anything, just learning and understanding concepts. When I started mastering concepts, I did it in a per subject basis as I have already outlined previously, pairing KA/KR mastery.
In the learning integration phase, feel free to go and reread parts you don't get. The main purpose is not to see how fast you can go through those books, but to make sure you get and understand the concepts. And sometimes you may have to go back and forth to do that.
Pathology
Patho/Pathophysio is the biggest topic in Step 1. Doing this right is critical if you want to pass Step 1. It is indispensable if you want to ace it. Patho is around 25% and Pathophysio is roughly 15% of the exam. So it is important that your review covers both patho and pathophysio. (FA has no pathophysio worth mentioning.)
1. BRS Pathology
One of the great books according to FA and they are right. It's a great guidebook for pathology since it covers the right concepts emphasize in the boards. Almost good enough to be a standalone main text for pathology although you will need a supplement for some topics. However, its one glaring weakness is pathophysiology. It barely exists. Personally I used this book as my main guidebook for Patho.
2. Big Robbins
I used this as my main text for 2 reasons. I needed to supplement BRS patho on some patho concepts and I need to cover the glaring weakness of BRS patho in pathophysiology. period. Please understand that I did not read everything in Big Robbins. I read all topics covered in BRS pathology and just scanned and familiarized myself with the rest. You don't need any supplementary text to Big Robbin's. It is the bible of pathology!!!
3. Goljan Lectures and Notes
You can use Goljan lectures and notes to substitute for big robbins. Goljan lectures covers pathophysio superbly (whenever you hear Dr. Goljan say mechanisms, that's Pathophysio) and the notes can supplement weak patho topics in BRS Patho. However, in my opinion though, it is still inferior to Big Robbins. If you like lectures more than reading this may be the thing for you but you need to use both lectures and his 500 page notes, not just his lectures. If you're thinking of acing the exam, you may still need big Robbins as supplement.
4. NMS Pathology
Although it gives fair coverage to both patho and pathophysio, I feel it is extremely inferior to Big Robbins or Goljan to be Main Text. Although, it covers high yield stuff, it is not as efficient in this as BRS Patho. So it remained in my shelf unused.
5. Robbin's Reveiw of Pathology
The BOOK for Patho KR. covers both patho and pathophysio superbly. The best way to master any topic is to KA/KR by topic and this is the best book to do that. Random recall is a requirement of the board itself and you should use online QBanks to drill that. KR mastery requires recall topic by topic and this book is it.
6. Kaplan Notes Pathology
Never used it. With lots of far superior materials available and Goljan lecture and notes overshadowing it. Have scanned through it, good material but not as good as others.
Pharmacology
One of the big 3. Roughly 14 to 15% of step 1. Big topic. Huge number of drugs to master, know and be familiar with. Since I graduated so long ago and an IMG to boot, the sheer number of unfamiliar drugs felt overwhelming. However in order to do well in the boards, you need to do well here.
1. Katzung and Trevor's Pharmacology or little Katzung.
Hands down best book for reviewing Pharma. As I said before, It lists the prototypes you have to master, the major derivatives you have to know and the obscure derivatives you have to be familiar as belonging to that drug class. Great review questions after each topic for mastery cycle. Only problem is not enough material in the book itself to master what it said you should master. So needs a supplement. Used this both as guide and main text.
2. Lippincott's Pharmacology
Nice basic text in Pharma. covers all major prototypes in detail. Problem is does not cover enough drugs. Using this as supplement to little Katzung however covers the right number of drug just adequately. A better supplement to little Katzung would have been Big Katzung. But in my situation, I feel I needed an introductory book in pharmacology to massage my way into it. And Lippincott filled this bill nicely.
3. Katzung's Basic and Clinical Pharmacology or Big Katzung.
Nice big book, covers all materials superbly. Pharmacology Equivalent to Robbin's. Although I had used little Katzung and Lippincott's primarily, I do occasionally find myself running to Big Katzung. If I had 2 weeks more to review, would've use Lippincott for the learning phase and switched to Big Katzung for the Mastery phase.
4. NMS Pharmacology
Has all the disadvantage of Lippincott but none of its advantage. It covered most drugs in detail. Sometimes in too much detail and yet is missing a lot of drugs. Didn't bother to use it.
5. Kaplan Notes Pharmacology
Great coverage of Pharmacology. Could replace little Katzung but still far inferior to it. Would still need big Katzung or Lippincott's as supplement. Went through it about a week before the exam just to check if I missed anything important. Seems I did not.
6. PharmCards
Flashcards are great tools for recalling on a per drug basis. It is easier to master pharmacology on a per drug class basis, prototype, major derivative, more obscure derivative. However, examinations require you most of the time to recall on a per drug basis. Flashcards are the most effective way to do that. Of course you can easily make your own flashcard, don't really have to buy one.
Micro-Immuno
The third member of the Big 3. This was my weakest subject in Med School. Not to mention that immuno was non-existent during our time. Didn't even dare schedule my exam until I know I can handle this portion. Micro-Immuno combined is about 14 to 15% of step 1.
1. Medical Microbiology and Immunology by Levinson and Jawetz.
Rarely do you find a book that can act both as a guidebook and main text without need of a supplement. Excellent coverage of Immunology to boot. The questions are good for KR mastering. There are no explanations to answers but you can quickly consult the book since the exam is done by topic.
2. NMS Microbiology
Although inferior to Jawetz, used it only for superb coverage of chemotherapeutics. Chemotherapeutic drugs from the point of view of Microbiology rather than Pharma. MIcro concentrates the discussion more on how the drug affects particular organisms than Pharma does.
3. Kaplan Notes Microbiology and Immunology.
Very good coverage of Microbiology and Immunology although inferior to Levinson and Jawetz overall. Still can substitute for Levinson as both guide and primary text. extremely good presentation of differential microbio. Used it at about 2 weeks before exam to check if I missed anything important. Didn't noticed any.
4. MicroCards
Flashcards are good way to train recall by organisms. KA with books, KR with Flashcards.
Behavioral Science
My Personal Waterloo maybe because I'm IMG. about 10% of the exam. Watch out because QBank weighs this only at 5% and if you're weak here it can skew your correlation. This was my weak point both in NBME and Qbank and if anything will screw up my final score, this will be it. Always had problems with social and patient encounter quesions. In my exam 2 out of 5 BS questions was of this type or about 40% of BS or 4% of the whole STEP 1!! So the potential that this will screw up my score is really big. Have not found a way to handle this problem and I will leave it to wiser minds than mine to figure out how to tackle this beast.
1. BRS Behavioral Science
Good Coverage of BS topics. However, does not seem to make a difference when it comes to social type questions. Was able to answer all its social q's correctly but still manage to screw it up in both NBME and Kaplan QBank. (What I mean by screw up is I was getting only 1 out of 5 questions right, not much different from randomly selecting an answer. And if that ratio holds I will be giving up over 3% in my step 1 score just on this type of q's alone)
2. Kaplan Notes Behavioral Science
Same comment as BRS. What else can I say. My QBook score after reading this was 82% and 86%. The 2 lowest grade I got in the whole QBook.
Biochemistry/Genetics
Probably one of the hardest subject for old graduates like me. There are just too many new concepts since we were last in school to learn. So needed a good introductory book.
1. Kaplan Notes Biochemistry/Genetics
Found this to be the best coverage in the whole Kaplan series. Superb Biochem and Genetics. However, when I first read it, it was too complicated for me. So had to use an introductory book. However, if you are a relatively new graduate, this book is good enough for both guidebook and main text.
2. Lippincott's Biochemistry
Very good introductory book to Biochemistry. Many concepts can be mastered using this book, but genetics part a bit weak..
3. NMS Biochemistry
Good book for Biochemistry also but not as good as Lippincott's. Stronger genetics than Lippincott's Bought this book before Lippincott's, but still needed Lippincott's to understand Kaplan.
4. NMS Genetics
Good coverage of Genetics, but covers too many topics not tested by the board. No choice for me since I needed a more basic book in Genetics to understand concepts tested in the board. So personally used this to help learn Genetics from scratch.
Physiology
Most of Physiology is Pathophysiology, so pure physiology is so much less covered in USMLE. The dilemna is should I learn Pathophysio with Physio or Patho. Actually the best answer is a little of both. Some Pathophysio is better learned with physio, ie. Acid base, renal, etc. While some are better learned with Patho, hematology, etc. My basis for choosing books in physio is coverage of both physio and pathophysio.
1. BRS Physiology
Very good guidebook for physiology. Very weak pathophysiology. Used this mainly as guidebook.
2. NMS Physiology
Too dense to be guidebook, but good enough for main text. Superb coverage of Acid Base. A bit weak in Cardio and Neuro. Covers both Physio and Pathophysio. Warning: a bit of a hard read, Guyton is easier to read but so much longer.
3. Guyton's Medical Physiology
Used this mainly as a supplement to cover for NMS Physiology's poor coverage of Cardio and Neuro. Great coverage of both physio and pathophysio.
4. Kaplan Notes Physiology
Very good coverage of Physiology. Pathophysiology a bit weak. Personally used this to check if I missed any important concept.
Anatomy/Neuroanatomy
Probably the least reviewed subject in Step 1, it nevertheless is about 8% of step 1. Because of the huge amount of info to learn compared to the weight given to it in Step 1, it is low yield. But for people wishing to ace the exam, you have no choice. You can't afford to have a weak point or fail to address it. The reason is that if you are aiming just to pass or getting a score below 99, you can afford to cover weak points by getting higher marks in your strong subjects. However, when you are trying to score past 99, usually your strong subjects are already in the highest level and any glaring weakness can really pull you down. Probably the most important thing to master here is Brachial Plexus, Lumbar Plexus, Inguinal region, Hepatic-GI areas. In Neuro, probably spinal cord, Brainstem, Cranial Nerves and Cerebral Cortex (esp. blood supply and deficits)
1. NMS Clinical Anatomy
Used this as my main text. Some topics not covered adequately and sometimes the writing can be obtuse.
2. Grant's Method of Anatomy
Used this as a supplement, whenever NMS becomes obtuse.
3. Ridiculously Simple Anatomy
Use this as guidebook and KR tool. Some people would recommend that you use only this for study. Would agree only if Anatomy is still relatively fresh in your head.
4. BRS Neuroanatomy
More than adequate coverage of Neuroanatomy. Although personally used this as main text, it is more than what is needed for Step 1.
5. HY Neuroanatomy
Very good coverage of Neuroanatomy, would recommend to use this as main text and use BRS only as supplement.
6. Kaplan's Anatomy
Coverage is really inadequate for the purpose of Step 1. period.
The little 3.
These are Embryology, Histology and Cell Biology, Molecular Biology. These 3 topics combined probably accounts for less than 5% of Step 1. Had to study them since, I was an old graduate.
1. Langman's Embryology
Very complete with good clinical correlations. Suffice to say, it's depth of coverage includes relevant topics in molecular biology.
2. BRS Histology and Cell Biology.
Very good coverage of Histology and Cell Biology but lacks pictures. (Most of your Histo Q's will include pics) Used as main text and guidebook.
3. Histology: Text and Atlas.
Used only as supplement for the pictures. Pored over the pictures whenever I have free time.
For Molecular Biology, I really didn't find any one book that covered it. Most of what I got on it were from the following sources.
1. Big Robbin's
In most discussion of big Robbin's, Molecular Biology concepts are covered at the appropriate sections
2. Kaplan Notes, Biochemistry and Genetics
3. Langman's Embryology
Especially as they relate to embryological development
4. BRS Histology and Cell Biology
5. The internet
I just googled sites on the internet on caspases, p53, transcription factors, etc. and read up on them.
That's it. These are my book sources, why I chose them and how I used them. Our next topic will be KR.
___________________
Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| askdoc
Forum Senior
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We've finished discussing KA, now we turn our attention to KR.
The endpoint of our studies is to be able to recall what we've learned. Normally this should not be a problem. However, with the sheer amount of material we've to study in medicine, sometimes recall becomes a problem even if we know the material. Being unable to recall something does not necessarily mean we do not know it.
A lot of times, we are faced with a question which we can't answer, but once we see the answer, we go "Yes, I remember this, now why can't I recall it earlier." This shows that you know it. However, for the purpose of the board, "what you cannot recall, you do not know". Therefore, as part of our preparation, we must improve our ability to recall what we've learned.
The usual way most people practice recall is answering QBanks. Back in the days before QBanks were readily available, we use flashcards, notes, or even study groups where we take turns asking each other questions and answering them. Most people still do this, but others just go for QBanks.
As discussed before, your ability to recall concepts can be categorized to Mastery, Know or Familiar, depending on the amount of information you can recall about the particular concept. We've also discussed that you cannot KR at mastery level what you've KA'd at a lower level.
The purpose of KR practice is to raise your KR level to the same level you had KA'd the concept. And the best way to do that is to do practice recall.
For the purpose of the board, there are two ways we tend to do recall.
1. Recall by the topic - This is the easier way to recall concepts. We tend to study related concepts together so we tend to recall them together too. Most people who like to group their QBank questions by topic will notice that they tend to get a higher score too than when grouped in random order.
2. Random Recall - This is the harder way to recall concepts, but this is the way the board requires you to recall concepts. When you group your QBank Questions in random order, you will notice that your score tends to be lower than when grouped by topics.
Why is this important? Because while the best way to improve your KR is to practice recall by the topic, the board requires you to recall concepts randomly and this dichotomy has caused havoc in some people's study methods.
People would group their Q Bank questions by the topic, practice with them and see a steady increase in their Q Bank Score. These people knew instinctively that this is the best way to master a topic. However, because the board requires you recall concepts randomly, they get a lower score than they were expecting when they sit for the board.
Now people have caught on, so they start by doing Q's randomly. Now you have the opposite phenomena, People doing question after question and their scores are barely budging or going up very slowly. Doing random Q's is a less than ideal way to raise KR levels as I've explained before.
Some people use part of the QBank by grouping them into topics and part of it by grouping them randomly. However, since a lot of people is also using the same QBank to raise their KA and not just their KR, they tend to run out of questions before they can accomplish both. Also this tends to screw up QBank correlation with USMLE scores. Good thing NBME came along.
The best way to raise mastery levels on any concept is to do KA and KR in cycle by the topic. This way you increase both KA and KR at the same time. You also tend to raise them to the same level which is ideal. You must also remember that everytime you consciously recall a concept you increase your retention of that concept just like revising it. It is self-reinforcing so it is more efficient. Therefore, it is better to couple your KR with your KA rather than doing KR separately. I call it the mastery cycle. Do this only when you are already revising and not when you are still learning the material.
If you've already finish your revision and are just doing KR and cannot do a Mastery cycle for your revision, then do your KR by the topic. The questions tend to be related and reinforce each other, increasing your retention. Random Q's are unrelated, so they reinforce each other less. Therefore less efficient in raising your mastery level.
The reason why I recommend qbooks like Robbin's Review of Pathology, or the questions found at the end of chapters of little Katzung, is that their questions per topic tend to test you on that topic exhaustively. The only way that you will tend to get that benefit in QBank is to use up all the q's on that particular topic, leaving nothing for when you need to use it for Random Q's. It does not mean you cannot use it, just not that ideal.
Isn't it best to practice recall using QBanks that use CBT format rather than books, since that is how we're tested? Yes, but we will practice with QBanks with CBT format too. But for the purpose of increasing KA and KR of a topic, you need QBanks that test for the topics exhaustively and those books are more ideal for that purpose.
Once you've raised your KR to the appropriate level, your next task is to practice your random recall. Since there is also a time limit imposed by the board, you have to practice so you can do random recall fast. I already gave the reason why you need to do so before.
I've also outlined a way to do that before, but I will repeat it here in more detail. The best way to increase your random recall speed is to train it. You can do this by doing what I call the "Answer 50 questions in under 30 minutes without review" method. It is important that you use a Qbank that is in CBT format, so you get use to clicking the "next" button and the timer running down on top of the screen. The "next" button is the only navigation button you should be using during this practice session. (and also "end" button)
Now the reason people usually find it hard to go to the next question, is that they care about the question too much, so it is best to use what I call throw-away QBanks for your practice. BSS, Rapid Review and other obsolete QBanks are ideal for this. Kaplan QBank and other online QBank may be too "precious" to throw away.
I recommend that you start doing this early in your preparation, probably after finishing your learning phase, but before you do your revisions or mastery cycle. 2 blocks everyday or every other day. Your score will be terrible however, by the time you will be doing your online QBanks, you will be able to do your first rounds in record time with good results giving you more time to review them. Do your online QBanks in the traditional way, with full review.
Another reason to do this is that when you are used to doing question blocks in 30 minutes or less, 1 hour starts to look like a long, long time. The tension goes down, since time is really relative.
If I apply this method you've outlined wouldn't it take an inordinate amount of time? Well, if you are an old graduate like me, who have to learn practically everything from scratch and want to ace the exam, then yes. It took me 7 months and depending on your reading speed and IQ, you should give or take another 1 to 2 months.
However, if you are a relatively new graduate and want to ace the exam, it will definitely be much, much shorter. My preparation phase consists of 2 parts, learning and mastery and just under 5 of those 7 months were spent on the learning phase. Only around 2 months was spent on mastery. For a new graduate, most of the concepts are still relatively fresh and your learning period is practically 0. Since you've probably already mastered more concepts than I had before beginning the mastery cycle, you may not even need 2 months. That's the reason, new graduates can use FA and QBank to pass Step 1. Depending on your reading speed and IQ, probably 30 to 90 days.
Now, if you are an old graduate, who only wants to pass in the exam, or do well but not ace it, you could use the "Master the Big Three, Know the Rest" protocol. Concentrating on the big three will probably reduce your learning time by 2 months and your mastering time by 1. So a total of 4 months should do it. Again depending on your reading speed and IQ, give or take 1 month.
Now, if you are a relatively new graduate who wants to do the Master the Big Three thing, well you might need even less time than the ones who want to ace them, again give or take a few weeks depending on your reading speed and IQ.
Personally, I used this method only on 5 subjects namely Patho/PathoPhysio, Pharma, Micro-Immuno, Physio and Biochem/Genetics. No Mastery cycle for anat, neuro, embryo, histo, cellbio , mol bio and BS, just revising and random QBanks. I had thought of doing this for BS, but 80% of my problem is with ethical, social questions not the rest of BS.
We will tackle Test Preparedness next and then we're done.
___________________
Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| p53
Forum Guru
Topics: 51
Posts: 804
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Congratulations, askdoc, for your great score!
good luck on step 2.
are you going to make it for match 2007?
Edited by p53 on 06/03/06 - 12:47 AM
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| p53
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Topics: 51
Posts: 804
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here is the criticism of rapid (speed) reading:
http://en.wikipedia.org/wiki/Speed_Read
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"Everything should be made as simple as possible, but not simpler." - Albert Einstein
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| drbin
Forum Guru
Topics: 27
Posts: 562
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Oh dear is this a debate forum????
i have never read this much posts supporting or criticising anybody's views before. Tolito thanks for leading me to this thread, or i would have missed this.
Askdoc, you are a real genius Sir, i personally found it very well written,only that it gives me a panic attack,bs I am only an average student striving to get through this,no genius ofcourse,and the knowledge that I am also writing the same exam which exceptional people like u also take,it almost shakes my nerves. it shows me hw much I have to improve myself before even register for it. U must be a great Physician, rather a terrible researcher.This is probably the best "ARTICLE"on USMLE and i like to name it " THE BEST THESIS ON HW TO TACKLE USMLE".
i dont find any reason why somebody has to be so sceptical about somebody writing in a forum like this,after all if it helps a lot of USMLErs in their prep, what is the bad thing about it????and if u had a really great score on NBME and then USMLE, thats ur achievement and u must have already proved that(hope ur result is out) infront of the boards which is the only thing that matters, y prove each and everybody in this forum that whatever u said is true and truth only?
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| askdoc
Forum Senior
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We've talked about how to discover problems in your exam preparation and how your knowledge level and the level of mastery expected of you by the board will impact your performance. We've also discussed some ways to improve the effectiveness of your KA preparation as well as improve your Recall ability. We've listed a way to decide which books you need and how to use them. Now we are at the last leg of a long journey, Test Preparedness.
In order to score well in the USMLE, we not only need to master the concepts being tested and be able to recall them at will, we also need to be able to do it in the manner and condition imposed on us by the board. I call this Test Preparedness.
The board requires us :
1. To be able to recall concepts randomly, and,
2. To be able to recall them fast.
I've already discussed how we could do this and would refer the reader to appropriate posts.
3. be able to answer questions posed in a clinical manner.
If you've incorporated into your KA, clinically oriented review books, eg. Blueprints or UCV, you should have no problem with this, but if you still are then I would suggest you buy PreTest Physical Diagnosis. Although this qbook is not ideal for Step 1 because it requires straightforward answers, usually just diagnosis which rarely happens in Step 1 (it's usually more complex than that), it does present almost all questions in clinical case format. You don't have to bother to answer the question, just try to identify the clinical disease it is describing. Your ability to recognize classic and less then classic clinical presentation will improve dramatically.
Another problem that may crop up in TP is inability to finish questions in the given amount of time. This problem can usually be attributable to reading speed or recall problem. If it's reading speed, then you have no recourse but to try to learn to read faster. I've already given some tips on how to do this. If English is your second language and you tend to have to translate in your head most of the time, you have to spend more time gaining more fluency in order to minimize the need to translate in your head.
If the problem is recall, It could be due to a KA or KR problem and you need to remedy it at the appropriate stage of your preparation. However, if it is a problem of random recall, doing more random q's will help. Performing speed practice and random recall drills as I've outlined before can improve this tremendously.
Another problem is when you started out fine in the first few blocks but could not finish in the last few blocks. As I've explained before, this could be due to a lack of mastery of the concepts tested and you should go back to KA and KR. Or it could be due to inability to recall information randomly which also deteriorates with fatigue. The solution is still speed practice and random recall drills.
I would like to state right out that there would always be some form of performance deterioriation in a long exam like Step 1, especially in the last few blocks. However, people differ in their ability to withstand stress and exhaustion and I believe this could be remedied by practice. Doing a CBT exam is doubly exhausting.
Make no mistake, I could read and study 8 or even 12 hours straight without problem. Oftentimes my work requires me to do 12 hour days or sometimes even 16 hours(the joy of being in an outpatient setting, no 24 hour duties), I may be physically tired but I can still perform. In front of a computer, I begin to feel it after 4 Hours. The reason why we tire faster in front of a monitor is because of eyestrain. Eyestrain is more severe when staring at a monitor because of 2 reasons. 1. Screen glare which forces you to squint. 2. Failure to blink. When we read books, we blink when we turn the page. When we work we blink constantly. The eyes uses up up to 25% of our energy, therefore fatigue due to eyestrain can be severe. Now you can try to adjust the brightness of the monitor, but the Font used in the exam question is such that lowering the brightness too much can make it much more difficult to read the questions.
Performance deterioration can vary depending on your capacity to withstand stress and your stamina, however, it can reach a point where you are even having trouble with concepts you have mastered and even low qd questions. This started happening to me by the 7th block. I was lucky that my mind didn't freeze on me. I've heard this happening to other people, their mind was just a complete blank. And the only way you can remedy this is by increasing your stamina by practicing. If I had realized this from the start this was how I would do it.
I was reserving Kaplan QBank for my test preparedness and final KR phase of preparation. This required me to use it only after my preparations were relatively over. That's why I used throwaway QBanks like BSS and rapid review for my speed drills. I started this 2 months into my review, even before I finished my learning phase. (You could imagine how terrible the scores I was getting) By the 4th month, I was even doing 5 blocks per sitting (with great scores, mostly in high sixties to low seventies). However, this was at 30 minutes per block so roughly about 2.5 hours not the 5 hours it would normally take for 5 blocks. I was doing 250 q's per sitting but fatigue was a factor of time spent staring at the CPU and not the number of q's answered. This was my first error.
I should've started practicing with throwaway QBanks probably on Month 3 of review. Doing a full 8 hour 7 Block exam, probably on a Saturday, since Sunday was rest day anyway. By the time I would be doing Kaplan QBank, I would've probably done a minimum of a dozen full 8-hour exam even if I don't do it every week. Then I would do 2 to 3 full 8 - hour exam with Kaplan Qbank to really simulate the actual examination. Will this help? Probably. I was not able to test this.
I had planned to subscribe to QBank on the last week of March right after doing NBME 1. For reasons I would not elaborate, I wounded up taking the NBME1 on March 31. I had told myself that if I got < 600, I would postpone the exam, > 600, its a go. So it's a go. Then somehow, again for reasons I would not elaborate wound up subscribing to it on April 9 or roughly 2 weeks before my exam date. I had planned to do at least 4 8-hour exams with qbank and the rest of it in groups of 3 to 4 blocks.
My first inkling of trouble began when I did 4 straight blocks of QBank. 84, 86. 84. 76. The performanc drop was actually shocking. I checked for exam difficulty by looking at the average performance of all Qbank takers which is always given with the result. No, the exam wasn't more difficult than the rest around 58 to 60. I thought it was a fluke. I continued with my mastering session for Patho (I had finished only 70%of it at that time) but was surprised by my poor performance. (86% on GI, the only chapter I repeated in Patho mastering). The next day, although I knew I felt a bit tired, the exam results were even more revealing 86, 78, 74, 72. I was staggered.
However, because of the previous day's results, I thought that it was not the result of a single day's fatigue. That one, since I was at the end of a long and gruelling mastery session sometimes running 12 hours a day, my stamina reserve is very low. Two, doing full 1 hour blocks for 4 straight hours is gruelling enough so that I could not recover within 24 hours. And three, having to do mastering session on Patho also takes its toll.
So I decided to skip 1 day of test taking, lightened my mastering session and retook the exam again. 2 exams.86, 90. good. Next day, 3 blocks. 84, 88, 86. OK. 3rd Day, 86, 92, 84, 84. 4 straight blocks, good performance. Now my worst fears were realized, it was about 10 days before my exam, I knew I had no time to fix this problem.
While mulling over it, I took the first examination the next day and got a 78. Why, because all 3 BS questions were on social and ethical issues and I got all 3 wrong. Normally, QBank would present BS q's 2 to 3 questions per block (Actual USMLE was 5 to 6 per block) And I would get at least 1, 2 or even 3 right so long as, you got it, no social or ethics question. That precipitated the incident in Kaplan Forum. KREJ suggested practicing on more BS q's. Pointing out that NBME 740 and average 83% (at that time) Qbank would mean an already very good score.
So decided not to postpone the exam. Instead, continued with QBank up to 6 days before exam leaving around 850 q's unanswered. Revise BS once more instead of doing q's (prob a bad move). Finished mastery session of Patho 4 days before exam. Did final recall check with FA 3 days before exam. Watched Ice Age 2 2 days before exam, Checked into hotel 600 meters from exam venue one day before exam.(Driving to the exam venue from home takes 1.5 hours without traffic)
What I could've done if I postponed my exam for two weeks. Probably, at least 3 or 4 8-hour exam simulation. Finished 850 additional Qbank q's and increased my recall of 850 additional concepts. Finally do more focused BS Q's. Probably 3 to 4 more days to build up stamina reserves for the actual examination.
So, it was a choice of trying to break some record (emphasis on the word 'trying', since there was no guarantee that doing what I planned with those extra 2 weeks would really fix my problem or really even improve my score) or acing the Step 1, which seems achievable with my NBME score and QBank Grade (84% by now).
Well, I didn't break any record, but I did ace the exam. 99/256. Not bad for an old IMG 17 years out of med school.
When I started this journey, it was very bleak. It seems OLD IMG and USMLE STEP 1 don't mix. It was so discouraging. I just kept in my heart, an old prayer which my church youth adviser gave me written in a plaque when I was still in High School. Most of you may even know it.
"God, Grant me the Power to change things that I can change,
The Serenity to accept things that I cannot,
and the Wisdom to know which is which"
I'm an Old Graduate. Cannot do anything about that except probably invent a time machine.
I'm an IMG. Cannot do anything about that unless I can go to an even further in the past and convince my Dad to let me go to the US to study Medicine.
But what is under my complete control is the amount of dedication and energy I can and will commit to this endeavor.
There is an old chinese proverb that roughly translate to this( If it does not sound "Confucian", blame it on my lack of literary skill)
"Success is the product of Talent and Effort,
A man of great Talent and little Effort;
A man of little Talent and great Effort;
The results are the same."
That's it folks. Thank you for being a great audience. I hope that someday someone would use this to break some kind of record or something. If not, then, if it helps those who have struggled for sometime with this to finally make it , increase the confidence of some that they can do better than what they had initially thought was in their power, then I guess it would all be worthwhile and I would be content.
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Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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| askdoc
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Posts: 102
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to p53: thanks. Actually I'll be doing the 2008 match. As an old IMG, I'll be taking Step 3 and try to get an Observership. I've no problem with US LOR, as I already have old batchmates and even younger batches than me willing to give me an LOR. They've been in private practice in the US for 5 to 8 years already. The difference between 17 and 18 years is to my mind too little to quibble about.
To drbin: I posted this to help people understand what the USMLE Step 1 is all about and given this parameters, how best to prepare for it. So many times people fail because they do not know how to do it. You must know the beast, before you can slay it. As to criticisms, expected it from the start. To paraphrase Jack Nicholson, Most people don't want to know the truth. Most are looking for that magic solution, that single review book that will allow them to ace the exam without hard work. And what I have just said is that that is not possible and deep in their hearts, they know it. As to my Step 1 Score, it's 99/256.
Thank you all for not posting too many questions while I rush to finish my post. If anybody wants to ask anything now, feel free to do so. I will answer them as best I can. By next week, I'll be busy starting my Step 2 preparation and it'll be some time before you hear from me again.
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Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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to gigiMD
Hope you are doing well in your revisions. Keep me posted on how you are doing and feel free to pm me if you need help
askdoc
___________________
Step1 99/256, Step 2 99/258, Old IMG, 1989 grad. A man's reach should exceed his grasp, or what's heaven for. http://blogs.askdoc-usmle.com
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